Cultural Phenomenon: The Medicalization of Schizophrenia


Having a simple cold in America can seem like a dramatic scenario. The flu-shot, for example, is sometimes looked to as if it is a save-all measure. The medicine we have, like the flu-shot, is obviously effective, but we cannot ignore the fact that we almost always turn to science to help us during these times. In contrast to this way of thinking, you say flu-shot, my mom says hot milk with turmeric. Headache, or sinuses acting up? You can take that pill from your local pharmacy, or you can put your head over boiling water and steam your face and nostrils to open up your airways. In other words, in our culture, why are pills the first choice we go to?

We must approach mental illness from a socio-cultural lens to better understand different treatments for a variety of disorders – schizophrenia is no exception. One of the main reasons why patients with schizophrenia face obstacles on the path to treatment is because of the stigma surrounding the illness. In fact, it has been reported that 1 in 5 individuals would be unable to maintain a friendship with someone with schizophrenia (Stuart 2001). This social distance forces patients to be isolated which then affects their health, as social relationships have been seen to promote health and act as a buffer for negative effects caused by stress on the body (House 1988). This debilitating stigma also plagues India. Men hide their illness at their workplace to avoid the risk of ridicule from colleagues, while women with schizophrenia lose prospective marriages due to cultural myths that lead to discrimination (Loganathan 2011).

There is a stark contrast between the diagnoses of mental illness between the Western and Eastern hemispheres, which thereby affects the treatment procedures; schizophrenia is no stranger to this. To the general public, it can appear that, sometimes, the West relies on pharmaceuticals and “aberrant” behavioral observations, which could lead to overdiagnoses (Van Dijk 2016). There are many reasons for this, most notably trying to explain the unknown using science or unfortunately, a reason for profit by Big Pharma (Wyatt 2012). Especially in American society, we tend to focus on biology as the underlying reason for schizophrenic cases. However, this is not the case in the East, including India. Eastern countries tend to rely more on natural remedies, or spiritual explanations, behind behaviors that cannot be readily explained by biological means.

Neurological and psychiatric disorders obviously have a biological basis, but we cannot deny the cultural perspective surrounding them. Different cultures change the label, interpretation, and meaning of different psychiatric disorders (Kirmayer 1989). In America, we are quick to diagnose and start prescribing various drugs to treat someone with schizophrenia. This may be the result of the way our country was formed. Indigenous people believed more in the spiritual side of different aspects in life, but when colonizers came, they viewed this as “strange” and “backwards” (Portman 2006). Following pharmaceutical avenues may be viewed as “better” or “more appropriate” in treating illnesses because (1) we rely too much on science (dating back to the Enlightenment and how those thoughts forever shifted the view to a science-based perspective) or (2) we bombard the public with drugs through direct-to-consumer advertising for monetary gain, leading people to believe they need to be treated even though this may not be the case (Leo 2009). On the other hand, India view psychosis or other hallucinations, including voices and visuals, through a more spiritual lens. Religion and spirituality play huge roles in everyday Indian lives, including in those living with schizophrenia. These two factors can influence treatment and coping methods.

India’s sacred relationship with religion and spirituality can be both a good and bad thing for its individuals with schizophrenia. These beliefs can manifest in either positive ways, which influence treatment outcomes, or negative ways, which lead to greater stigmatization of those with schizophrenia. As Americans, we are used to seeing aspects of spirituality and “the great beyond” in televisions and movies – take for example, Will’s possession in Stranger Things. We think something like this can only happen in movies or novels – but never in real life. This isn’t the case for India, though; there, schizophrenia is either stigmatized or actually not diagnosed (Thara 2000). Instead, spiritual gurus will attribute these delusions to some sort of malevolent entity or possession. This, then, will deter possible treatments for those with schizophrenia. Indian society stigmatizes and discriminates against individuals living with schizophrenia. This leads to lower rates of people actually seeking help and leads to a sense of alienation (Koschorke 2014). Society will often shame these individuals and ostracize them, labeling them as “deviant.” In fact, individuals coping with schizophrenia don’t report their illness because they’re afraid of rejection and loss of marriage offers (Thara 2000). Interestingly, even though these explanations are not biological, when religion is associated with the treatment of schizophrenia, studies show that there are higher rates of treatment adherence and more positive coping methods (Grover 2014). For example, spirituality helps with patients’ well-being, both physically and psychologically. There are also studies showing that there is a better quality of life, which is most probably due to the positive correlation between religion and seeking help (Grover 2014).

If religion was seen as a helpful source for these patients, how can it also act a source of negative discrimination? Are we better off just sticking to a biological basis for understanding this disorder, like here in America? But if there are positive outcomes associated with religion and spirituality, can we integrate the two explanations? We should explore more options for better treatment of schizophrenia. If this means taking a holistic approach in addition to a biological one, we shouldn’t hesitate. This also means breaking down any biases we may have towards other approaches in treatment. Only then can we come together to offer the best treatment options to a variety of patients.

References:

Grover, S., Davuluri, T., & Chakrabarti, S. (2014). Religion, spirituality, and schizophrenia: a review. Indian journal of psychological medicine36(2), 119. Accessed 16 September 2018.

House, James S., Karl R. Landis, and Debra Umberson. “Social relationships and health.” Science 241.4865 (1988): 540-545. Accessed 30 September 2018.

Kirmayer, L. J. (1989). Cultural variations in the response to psychiatric disorders and emotional distress. Social Science & Medicine29(3), 327-339. Accessed 16 September 2018.

Koschorke, M., Padmavati, R., Kumar, S., Cohen, A., Weiss, H. A., Chatterjee, S., … & Balaji, M. (2014). Experiences of stigma and discrimination of people with schizophrenia in India. Social Science & Medicine123, 149-159. Accessed 16 September 2018.

Leo, Jonathan, and Jeffrey Lacasse. “The manipulation of data and attitudes about ADHD: A study of consumer advertisements.” S. Timimi & J. Leo (e.), Rethinking ADHD: From Brain to Culture (2009): 287-312. Accessed 25 September 2018.

Loganathan, Santosh, and Srinivasa Murthy. “LIVING WITH SCHIZOPHRENIA IN INDIA: GENDER PERSPECTIVES.” Transcultural psychiatry 48.5 (2011): 569–584. PMC. Web.Accessed 30 September 2018.

Portman, Tarrell AA, and Michael T. Garrett. “Native American healing traditions.” International Journal of Disability, Development and Education 53.4 (2006): 453-469. Accessed 25 September 2018.

Stuart, Heather, and Julio Arboleda-Florez. “Community attitudes toward people with schizophrenia.” The Canadian Journal of Psychiatry 46.3 (2001): 245-252. Accessed 30 September 2018..

Thara, R., & Srinivasan, T. N. (2000). How stigmatising is schizophrenia in India?. International Journal of Social Psychiatry46(2), 135-141. Accessed 16 September 2018.

Van Dijk, W., Faber, M. J., Tanke, M. A. C., Jeurissen, P. P. T., & Westert, G. P. (2016). Medicalisation and Overdiagnosis: What Society Does to Medicine. International Journal of Health Policy and Management5(11), 619–622. Accessed 16 September 2018.

Wyatt, W. J. (2012). Medicalization of Depression, Anxiety, Schizophrenia, ADHD, Childhood Bipolar Disorder and Tantrums: Scientific Breakthrough, or Broad-Based Delusion?. Postępy Nauk Medycznych. Accessed 16 September 2018.

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